Flexible and Focused

Teaching Executive Function Skills to Individuals with Autism and Attention Disorders

Adel C. Najdowski

• Publisher: Academic Press
• Year: 2016
• ISBN:
  9780128098349
• Topic: Psychology
• Subtopic: Psychotherapy Counselling
• Index: Psychology

Flexible and Focused: Teaching Executive Function Skills to Individuals with Autism and Attention Disorders is a manual written for individuals who work with learners who struggle with executive function deficits. The manual takes the perspective that executive function skills can be improved through effective intervention, just like any other skills. This how-to manual provides practical strategies for teaching learners to be focused, organized, flexible, and able to effectively manage themselves. Ready-to-use lessons, data sheets, worksheets, and other tools for practitioners, educators, and parents are provided to help them tackle common problems associated with executive function deficits in learners of any diagnosis, ages 5 to adult. The principles of applied behavior analysis (ABA), which form the foundation of this manual, are translated into simple, easy-to-use procedures. Lessons for improving executive function skills in real-life everyday situations are provided in the following areas:

• Self-awareness
• Inhibition and impulse control
• Self-management
• Attention
• Organization
• Problem solving
• Time management
• Planning
• Working memory
• Emotional self-regulation
• Flexibility

• Provides an overview of what constitutes executive function skills
• Outlines how techniques based on applied behavior analysis can be used to teach skills
• Presents step-by-step lessons for practitioners, educators, and parents to implement with individuals with executive function deficits
• Includes data sheets, task analyses, worksheets, and visual aids

Chapter 1

Introduction

Abstract

The term executive function is traditionally used to refer to the “chief operating system” located in the prefrontal region of the brain, which is used to engage in cognitive processes required for goal-directed behavior. Some common executive function processes used for goal-directed behavior include self-awareness, inhibition, self-management, attention, organization, problem solving, time management, planning, working memory, emotional self-regulation, and flexibility. This chapter defines executive function from both traditional and practical standpoints. Subsequently, it explains how this manual will help practitioners, educators, and parents teach executive function skills to individuals, from school-age to adults, with executive function deficits. All populations with executive dysfunction are included, such as autism spectrum disorder, attention deficit hyperactivity disorder, dyslexia, traumatic brain injury, and learning disabilities.

Keywords

Applied behavior analysis; attention deficit hyperactivity disorder; autism spectrum disorder; executive dysfunction; executive function; self-management

The term executive function is traditionally used to refer to the “chief operating system” located in the prefrontal region of the brain, which is used to engage in cognitive processes required for goal-directed behavior. Some common executive function processes used for goal-directed behavior include working memory, task initiation, sustained attention, inhibition, flexibility, planning, organization, and problem solving. If you aren’t already familiar with executive functions, it probably sounds like a complicated mess. If you’re already confused, don’t worry, I can honestly say that is how I felt the first time I learned about executive functions.

From a practical standpoint, the easiest way to explain executive functioning is to give you an example of what I would tell my grandmother if she asked me to explain it. Executive functions involve everything that you do every day to manage your own behavior. For example, this could involve all the behaviors it takes to make it to an appointment on time. First, you have to plan in advance by scheduling your appointment (i.e., planning). You choose a free time that is in your schedule that will still allow you to get to all your other responsibilities, including drive time and buffer time in case something goes wrong. If you need to dress a certain way for the event or will need to bring items you don’t have, you will shop at least a day or two in advance for new clothes or needed items. The night before the appointment, you will think about what needs to be done and potentially get some of the tasks done that night such as filling up your gas tank with gas, ironing and laying out your clothes, packing your bag in advance (i.e., organization), and determining whether you will need to bring drinks, snacks, or a meal, and what you will bring. You will also calculate how far you have to drive and how long it will take depending on traffic, and decide by what time you should leave your house. Then, you will consider how long you will need to take a shower, eat breakfast, and gather last-minute drinks and snacks in order to leave the house on time. After these calculations, you will set your alarm clock so that you can get up at the time planned (i.e., time management). When the alarm goes off the next morning, you will initiate the task of getting ready to leave the house (i.e., task initiation). You will remember what needs to be done (i.e., working memory) and stay focused on relevant tasks (i.e., sustained attention) in an effort to leave the house on time. You will avoid becoming distracted by social media, phone calls, or additional activities that will deter you from getting ready on schedule (i.e., inhibition). As you start driving to the appointment, you notice that the freeway exit you are supposed to take is closed, so you decide you’ll have to get off at the next exit. While you are in the car, you take a sip of coffee and spill it on your white blouse. You look at the time and realize you don’t have enough time to stop somewhere to try to clean out the stain, so you decide you will wear a cardigan that you have in your car over the blouse. Then, the next opportunity you get to use the bathroom, you will try to wash out the stain (i.e., problem solving and flexibility). You arrive to your appointment with a couple of minutes to spare. You scope out the location of the bathroom and decide you’ll go there when the opportunity arises.

Wow! Did you ever realize just how much self-management goes into making it to one appointment? It’s no wonder that parents feel crazy when their children are young. They are not only engaging in self-management but they are also managing their children, since their children don’t yet have the skills to do many things independently. Then, as children age, parents start slowly doling out some of the responsibility to their children. Many typically developing children do great with taking on the additional responsibility, yet others just can’t seem to wrap their heads around self-management. Such disorganized children get easily distracted and forget what they are doing, leading their parents to nag them to complete a task such as getting ready for school. Due to their distractibility, children with executive dysfunction are often late to school and extracurricular activities. They lose their personal belongings such as sweatshirts, water bottles, and soccer balls, because they forget to bring them home when they go on an outing and they can’t remember where they left them. They even lose their personal belongings at home because they don’t put things away. They forget to bring home the books they will need for homework, and when they do their homework, they forget to turn it in. Their backpacks, desks, and closets look like a bomb went off and are completely unkempt. They act impulsively and do things without thinking about potential consequences. They get stuck easily when problems arise and are inflexible with solutions and let their emotions get out of control. It’s exhausting thinking about what that means, not only for the parents, but also for the learner, who is receiving the brunt of disapproval from caregivers, teachers, and coaches.

1.1 How Can This Manual Help?

Although traditionally executive functions are considered brain functions, there’s something you should know about me before continuing to read this book. I am not a neuroscientist; I have a doctorate in psychology and am a Board Certified Behavior Analyst (BCBA-D). Given that my background is behavior analysis, I believe that all executive functions involve behavior. For example, the brain function of memory involves someone engaging in behavior. To remember the name of a person they just met, they may rehearse the name once or twice, think of another person with the same name, or ask the person how they spell their name so that they can visualize the spelling of it. All of these are considered behaviors one engages in that get lumped into the brain function of memory. I also believe that behavior can be learned and strengthened by one’s experience in one’s learning history and environment. Thus, although individuals with executive function deficits may appear to have the inability to engage in the associated behaviors, I believe that if even a small portion of executive function performance is learned behavior, we should be able to improve it. My saying that executive functions involve behavior should in no way be interpreted as denying that the human brain participates. Rather, it is my way of saying that, as behavior change-agents, we should make the most of what we can do to teach behaviors that will allow individuals with executive function deficits to participate to their fullest in goal-directed behavior. There is no pill or brain surgery yet that can fix brain mechanisms that may not be working at their fullest, but there are principles and procedures of learning and motivation that are proven to help people learn. Put simply, the aim of this manual is to harness these principles and procedures to provide tools for practitioners, educators, and parents to help learners improve their executive function skills.

1.2 Who Can Use This Manual?

Do the examples of the chaotic behavior outlined earlier sound like your child or a learner with whom you are working? Are you interested in teaching the learner ways to engage in self-management? If so, this manual is for you! My goal in writing this manual is to provide easy-to-use lessons, data sheets, and tools (for printable tools, see the companion website to this manual) for practitioners, educators, and parents to tackle common problems observed in learners with executive function deficits.

1.3 What Type of Learners Will Benefit From This Manual?

This manual was written for kindergarten to adult-aged learners. I have been working with learners diagnosed with autism spectrum disorder (ASD) since 1995, so there’s no question that this population is my passion and specialty. However, the principles and procedures of applied behavior analysis (ABA), which form the foundation of this manual, are equally applicable to all populations. ABA is based on principles of learning that apply to all humans and is used to change behavior in meaningful ways. For example, ABA can be used to achieve weight loss, increase physical activity, reduce smoking, increase work productivity in organizations, and improve fluency in math and reading skills, to name a few. Thus, any learner with executive function deficits can benefit from the procedures outlined in this manual. If you are unsure if the learner with whom you are involved needs this type of intervention, an assessment of executive functioning such as the Behavior Rating Inventory of Executive Function: BRIEF (Gioia, Isquith, Guy, & Kenworthy, 2000) should be conducted by someone qualified to administer it.

In addition to ASD, other diagnoses that are commonly associated with executive function deficits include attention deficit hyperactivity disorder, dyslexia, traumatic brain injury, and learning disabilities. Each diagnostic population has its own unique characteristics, but practically speaking, the diagnosis matters less than matching effective teaching procedures to the particular skill deficit you are trying to remediate. If you know a learner who has the types of executive dysfunction challenges discussed so far, then he or she can likely benefit from the training procedures described in this book.

1.4 A Consideration for Board Certified Behavior Analysts (BCBAs)

When insurance is the funding source for ABA-based intervention, BCBAs are not able to write goals for learners that are considered “academic.” Some of the lessons in this manual may appear important for the learners with whom you work, yet you may feel your hands are tied in that you are not able to target such skills. In this case, consider targeting the skills using parent training goals, and teach parents to implement relevant lessons. In addition, many of the skills described in this book directly or indirectly affect the behaviors that are the core diagnostic symptoms of ASD, so linking executive function skills to ASD symptoms can be helpful in clarifying how the treatment procedures contained in this book may be medically necessary for the learners with whom you work.

1.5 Format of This Manual

This manual was written from a practitioner’s standpoint. My goal in creating this manual was to provide ready-to-implement lessons for executive functioning skills. You might have already noticed that I have written this book in casual, easy-to-read language. Just about all of the principles and procedures in this book come from experiments published in scientific journals, filled with stuffy, boring language. The “References” section and the “Additional Resources” section (Appendix A) of this book are where you can find many of these publications, and I encourage you to consult them, if you feel so inclined. In technical terms, the skills you will be teaching with the lessons in this book are based on complex intraverbals, rule-governed behavior, stimulus equivalence, and relational frame theory. For the researchers reading this book, and for anyone who may be curious, we recommend you check out the readings on these topics in the references and appendix. But for the purposes of remaining practical and consumable, the language contained in this book is intentionally down-to-earth and everyday. You might even find yourself noticing that it feels like you are talking to me, one-on-one. If that’s the case, then great! For the scientists reading this book, I hope you can put your practitioner hat on long enough to appreciate the casual tone. For practitioner and parent readers, this book is specifically written to be useful to you, and I hope you enjoy it.

Chapter 2, Principles Behind the Lessons, provides the behavior analytic principles to be employed within the lessons in the remaining chapters. Chapter 3, Self-Awareness, Inhibition, and Self-Management; Chapter 4, Attention; Chapter 5, Organization; Chapter 6, Problem Solving, Time Management, and Planning; Chapter 7, Working Memory; Chapter 8, Emotional Self-Regulation and Flexibility, are organized by executive functions. The division of chapters by executive functions suggests that executive function skills may be independent of one another; however, it is actually the case that many executive function skills must be used together within the lessons that appear in the chapters. For example, when attending, one is also using inhibition by avoiding distractions and working memory when remembering the task at hand. Keep this in mind when choosing lessons to work on with learners. You may think the learner does not have issues with attention, e.g., only to realize later that attention deficits are impeding the learner from making improvements in planning skills (because the learner does not attend to the planning task). The lessons provided within the chapters include data sheets, worksheets, and visual aids that can be implemented when teaching. Finally, Chapter 9, Troubleshooting, provides ideas for troubleshooting should problems arise as you begin to implement strategies. Rest assured, problems will arise, as there is no one-size-fits-all cookie-cutter approach that will work for every learner. There is also no way that I could possibly think of all the problems that you may encounter, but it is my hope that I have at least touched upon some of the most common problems. Like all of the other work you do, the lessons in this book will need to be customized and/or extended in order to meet the individual needs of learners.

Chapter 2

Principles Behind the Lessons

Abstract

This chapter discusses several key principles of applied behavior analysis for teaching executive function skills to learners. For example, positive reinforcement, the key principle for teaching new behavior, is defined and considerations for successful implementation are provided. Ways to assist the learner to acquire new skills via prompting are offered, and methods and considerations for slowly removing or fading out prompts to promote independence are described. Chaining, a procedure for teaching skills that require multiple steps, is defined, and instructions and considerations for implementing three methods of chaining are provided. Methods to achieve positive outcomes of teaching, such as generalization to real-life settings and situations, as well as maintenance of newly acquired skills, are outlined. Finally, data collection and graphing are recommended for evaluating effectiveness of interventions.

Keywords

Applied behavior analysis; attention deficit hyperactivity disorder; autism spectrum disorder; executive dysfunction; executive function

Several key principles need to be applied in all the lessons presented in this manual. Rather than repeating them in every chapter, they are summarized here in one place. But make sure you remember to consider all of these principles as you adapt the lessons for learners. If you’re a behavior analyst, you may be able to skip most of this chapter; however, I would recommend that you read Sections 2.2 and 2.4, as I have included some nontraditional ideas in these areas.

2.1 Positive Reinforcement

Probably the most important thing to know about behavior is that a person is pretty much always either gaining access to something d...